Telstra Health UK Standard Extract Service Feed

Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Objective for processing

Aim and purpose of this application: Dr Foster Ltd has rebranded as Telstra Health UK. There is no change to how Telstra Health UK process the data received under this Agreement. Dr Foster Limited (Dr foster) has provided objective insight and analysis since 1999. Dr Foster’s aim is to help health and social care organisations to make better and faster decisions with data and insight and, ultimately, to benefit patients. This is delivered in three main strands: The Dr Foster name and branding is being kept around the Telstra Health UK benchmarking tools and services, so users will see some legacy branding as well as HIP now referenced as the “Dr Foster Healthcare Intelligence Portal”. Providing high quality, data-led population health management in the UK is the main priority for Telstra Health. That is why Dr Foster is being rebranded to Telstra Health UK. The commitment to continuing investment in the UK health sector offers the perfect opportunity for Telstra Health UK to keep improving the health data and analytics services they deliver. Dr Foster has a long and proven-track record of analytics-led benchmarking and performance improvement for healthcare providers in the UK, which they remain committed to and will continue to deliver and innovate on. Telstra Health UK (formerly Dr Foster)has provided objective insight and analysis since 1999. Telstra Health UK’s aim is to help health and social care organisations to make better and faster decisions with data and insight and, ultimately, to benefit patients. This is delivered in three main strands: [3 paragraphs unchanged] The data requested under this agreement Agreement are initially sent to Imperial College London Dr Foster Unit (ICL DFU) under a separate agreement Agreement DARS-NIC-12828-M0K2D. ICL DFU pseudonymise the data further and then securely transfer it to Dr Foster Limited. Dr Foster Telstra Health UK. Telstra Health UK is a completely different legal entity from ICL DFU. Dr Foster Telstra Health UK do not have any control over data held by ICL DFU. Please see 'Processing Activities' for more information on ICL DFU’s pseudonymisation of the data. Dr Foster Telstra Health UK funds ICL DFU and works closely with it on developing new methodologies to assist healthcare improvement. The development of new methodologies is achieved through the sharing of knowledge. This application is to renew the existing datasets and to add the Emergency Care Data Set (ECDS), so that it can be processed in parallel with the other data received under this agreement. This will allow tools and services that depend on Hospital Episodes Statistics Accident & Emergency (HES A&E) to continue once that is no longer available. It will also allow for related development work to ensure both that the services can continue and that new and more in-depth analysis based on ECDS can be offered. Data controller: Dr Foster requires the maximum overlap of ECDS with A&E data to provide continuity in its product line with respect to emergency care data. The existing analytical tools provide insight based on the A&E dataset that our current data sharing agreement permits us to hold (back to 2007/08), but any new tools developed to use ECDS data will have a much shorter period of historic data since it is not possible to map A&E data to the new standard. Telstra Health UK is the sole data controller for data provided under this Agreement (DARS-NIC-68697-R6F1T) who also processes the data for the purposes described within this Agreement. While Imperial College London provide Dr. Foster with the data described within this Agreement they do not determine the purpose and means of processing under this application. There is potential for duplication of data by processing both HES A&E and ECDS for the period from 2017/18 onwards. However, there will be gaps in the ECDS for this period as Trusts became accustomed to sending the new data. Processing both datasets will allow Dr Foster to account for these gaps and provide its customers with historical emergency care insight and analysis that's based on the most complete data available. General Data Protection Regulation legal bases: Dr Foster has applied for the maximum period of ECDS data available to mitigate this shortfall as much as possible. Telstra Health UK process the data under General Data Protection Regulation (GDPR) articles 6(1)(f) (legitimate interests) and 9(2)(j) (archiving in the public interest). Telstra Health UK determined the legal bases by undertaking a legitimate interests assessment and a data protection impact assessment. These documents are maintained and updated as necessary by Telstra Health UK. Data controller Telstra Health UK has a legitimate interest in being able to provide tools and services that healthcare organisations will find useful and that will benefit the health and social care system. Without processing this data, Telstra Health UK would not be able to deliver these tools and services. Withdrawing these would be to the detriment of health professionals who use them. Telstra Health UK's customers can be assured that the tools and services are based on evidence provided by data from a trusted source. There is no viable alternative as relying on public domain data would lead to gaps and not allow the same support for decision making. Using pseudonymised data allows Telstra Health UK to deliver evidence-based insight and analysis while minimising intrusion into a patient's privacy. If patients are uncomfortable with their data being used for purposes beyond their care, then they may manage their patient data choices via the National Data Opt-Out. Dr Foster Limited is the data controller for data provided under this agreement (DARS-NIC-68697-R6F1T). The processing of this data is also necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) of GDPR. The processing is proportionate to its aims, respects data protection rights and provides suitable and specific measures to protect the rights and interests of individuals. It is necessary for reasons of public interest in the area of public health, in particular to ensure high standards of quality and safety of health care. Although Telstra Health UK are not a public body, they provide services to help public healthcare organisations to monitor and improve their services. Processing is designed to benefit patients and society as a whole through better healthcare. General Data Protection Regulation legal bases This Agreement permits access to data disseminated by NHS Digital to ICL DFU under a separate Agreement. ICL DFU further pseudonymises the data (described in more detail in ‘Processing Activities’) and then is transferred securely to Telstra Health UK. Telstra Health UK cannot identify individuals in this data, but the additional pseudonymisation process means that authorised Telstra Health UK NHS customers can take an additional service through ICL DFU to identify patients in Telstra Health UK tools. Telstra Health UK cannot identify individual patients in the data and does not have access to the re-identification service. Dr Foster process the data under General Data Protection Regulation (GDPR) articles 6(1)(f) (legitimate interests) and 9(2)(j) (archiving in the public interest). Dr Foster determined the legal bases by undertaking a legitimate interests assessment and a data protection impact assessment. These documents are maintained and updated as necessary by Dr Foster. ICL DFU’s additional pseudonymisation of the de-identified HES data removes the HESID supplied by NHS Digital and replaces it with a new encrypted value that cannot be re-identified by Telstra Health UK. A unique identifier, known as the FOSID, is added by ICL DFU to each row of data. The FOSID is shared with Telstra Health UK. The FOSID allows Telstra Health UK to process data without being able to identify patients but at the same time allowing authorised NHS customers to use it with ICL DFU’s re-identification service. The re-identification service allows authorised users at care providers to further investigate patients under their care. The FOSID is used to extract the local patient identifier or NHS Number (LOPATID or NHSNO) so the care provider can review patients’ records. Telstra Health UK do not have access to this re-identification service and cannot see any re-identified data. This data all remains with ICL DFU under DARS-NIC-12828-M0K2D. Dr Foster has a legitimate interest in being able to provide tools and services that healthcare organisations will find useful and that will benefit the health and social care system. Without processing this data, Dr Foster would not be able to deliver these tools and services. Withdrawing these would be to the detriment of health professionals who use them. Dr Foster's customers can be assured that the tools and services are based on evidence provided by data from a trusted source. There is no viable alternative as relying on public domain data would lead to gaps and not allow the same support for decision making. Using pseudonymised data allows Dr Foster to deliver evidence-based insight and analysis while minimising intrusion into a patient's privacy. If patients are uncomfortable with their data being used for purposes beyond their care, then they may manage their patient data choices via the National Data Opt-Out. ICL DFU offer an independent service to Telstra Health UK’s NHS customers which allows the customers to re-identify patients in Telstra Health UK tools, although this service will soon cease operation . NHS customers with access to ICL DFU’s re-identification service use it to support many processes critical to delivering high quality health care services, for example: Dr Foster has a legitimate interest in continuing to offer its customers tools and services that provide insight and analysis into emergency care provision through the processing of the additionally requested ECDS data. Dr Foster also has a legitimate interest in developing new ways to help its customers improve their services and utilise the ECDS to its full potential. The healthcare professionals using Dr Foster's tools and services have an interest in knowing that the insight and analysis of emergency care data can continue and with the improvements offered by ECDS. This will allow a better understanding of capacity and demand and will be used to drive improved patient care, which is in the broader interest of everyone using the health and social care services in England. The processing of this data is also necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) of GDPR. The processing is proportionate to its aims, respects data protection rights and provides suitable and specific measures to protect the rights and interests of individuals. It is necessary for reasons of public interest in the area of public health, in particular to ensure high standards of quality and safety of health care. Although Dr Foster are not a public body, they provide services to help public healthcare organisations to monitor and improve their services. Processing is designed to benefit patients and society as a whole through better healthcare. Imperial College London Dr Foster Unit (ICL DFU) and additional pseudonymisation Imperial College London Dr Foster Unit (ICL DFU) is a separate legal entity to Dr Foster Limited. Dr Foster Limited do not have control over the data processed by ICL DFU. Data requested under this agreement is sent by NHS Digital to ICL DFU. ICL DFU further pseudonymises the data (described in more detail in ‘Processing Activities’) and then transfer it securely to Dr Foster. Dr Foster cannot identify individuals in this data, but the additional pseudonymisation process means that authorised Dr Foster NHS customers can take an additional service through ICL DFU to identify patients in Dr Foster tools. Dr Foster cannot identify individual patients in the data and does not have access to the re-identification service. ICL DFU’s additional pseudonymisation of the de-identified HES data removes the HESID supplied by NHS Digital and replaces it with a new encrypted value that cannot be re-identified by Dr Foster. A unique identifier, known as the FOSID, is added by ICL DFU to each row of data. The FOSID is shared with Dr Foster. The FOSID allows Dr Foster to process data without being able to identify patients but at the same time allowing authorised NHS customers to use it with ICL DFU’s re-identification service. The re-identification service allows authorised users at care providers to further investigate patients under their care. The FOSID is used to extract the local patient identifier or NHS Number (LOPATID or NHSNO) so the care provider can review patients’ records. Dr Foster do not have access to this re-identification service and cannot see any re-identified data. This data all remains with ICL DFU under DARS-NIC-12828-M0K2D. ICL DFU offer an independent service to Dr Foster’s NHS customers which allows the customers to re-identify patients in Dr Foster tools. NHS customers with access to ICL DFU’s re-identification service use it to support many processes critical to delivering high quality health care services, for example: [7 paragraphs unchanged] Dr Foster Telstra Health UK require the complete pseudonymised HES datasets, Civil Registration mortality data and the [11 words unchanged] improvements in their performance, to gain insight and to inform decision making. [8 paragraphs unchanged] Dr Foster Telstra Health UK use the data previously provided under this agreement Agreement to provide a management information function in the form of analysis and [7 words unchanged] increase the power of predictive models for rare diseases, procedures and events. Dr Foster Telstra Health UK build standard case mix adjustment models for 259 diagnosis groups and 200 procedure groups which include some rarer conditions. Using all the requested datasets means that Dr Foster Telstra Health UK have the most up to date information and can inform customers of [10 words unchanged] better informed decisions for the improvement of healthcare and outcomes for patients. At a high-level Dr Foster Telstra Health UK analyses break down into the following: [18 paragraphs unchanged] The data allow Dr Foster Telstra Health UK to provide a wide array of relevant indicators to give end users [6 words unchanged] performance as possible to allow health and social care organisations to effectively: [4 paragraphs unchanged] Civil Registration (Deaths) - Secondary Care Cut data are requested to provide more timely and accurate analysis and insight for Dr Foster’s Telstra Health UK’s customers. It is essential for performing survival analyses and so represents a very valuable source of data. It will improve the output of Dr Foster’s Telstra Health UK’s products for the benefit of NHS customers and for the broader improvement of health and social care for the public. [12 paragraphs unchanged] Dr Foster Telstra Health UK process the minimum data necessary to meet the purpose and build privacy [8 words unchanged] consisting solely of the replacement of HESID with FOSID, of the data. Dr Foster ISO 27001 certificate provides assurance over the security of the data Dr Foster Telstra Health UK have no requirement to re-identify the individuals within the data they receive and will make no attempt to carry out any re-identification. In the context of the above statement, while Dr Foster Telstra Health UK and NHS Digital recognise that the inclusion of record-level Date of Death [8 words unchanged] increase the risk of re-identification, for clarity it is pointed out that: a) as stated above, Dr Foster Telstra Health UK will not re-identify; in addition, given the volumes of data, identification will serves no purpose to Dr Foster. Telstra Health UK. b) raw Date of Death allows Dr Foster Telstra Health UK to carry out better analyses and provide a better service to their customers: - using an alternative such as “death 30/60/90 days from Discharge” does not enable the calculation of median survival rates, nor does it enable Dr Foster Telstra Health UK to produce aggregated survival curves - in some cases, Dr Foster Telstra Health UK calculates mortality rates with reference to particular Procedures not to Discharge; the [11 words unchanged] to be set at different events in different cases for different purposes c) record-level data is only shared by Dr Foster Telstra Health UK with customer Trusts only for those patients treated by that Trust [2 paragraphs unchanged] Dr Foster are amending their application to Telstra Health UK request Emergency Care Data Set (ECDS), this was initially received in parallel to HES A&E, A&E until the ECDS transition process is complete, so that it can: this allowed Telstra Health UK to: [4 paragraphs unchanged] Historical ECDS data is necessary for more useful trend analysis, research, and quality assurance. The additional fields within ECDS will help Dr Foster Telstra Health UK to: [5 paragraphs unchanged] Mental health fields within ECDS will be used by Dr Foster: Telstra Health UK: [6 paragraphs unchanged] A data period of 15 years of historical data is essential to enable Dr Foster Telstra Health UK to: [6 paragraphs unchanged] Users of Dr Foster Telstra Health UK products and services NHS subscribers to Dr Foster Telstra Health UK tools have access to analysis of the data so that they can: [2 paragraphs unchanged] Dr Foster Telstra Health UK online products are used by: [13 paragraphs unchanged] Dr Foster Telstra Health UK also work with: [2 paragraphs unchanged] Any request for such analysis is reviewed to determine if it benefits the health and social care system. Dr Foster Telstra Health UK will inform NHS Digital of analysis it provides to non-NHS organisations and will list this in any renewal or amendment to this. Dr Foster Telstra Health UK provided analysis on COVID-19 to the British Red Cross in May 2020. This was frailty analysis by Lower Super Output Area (LSOA) which included the following: [3 paragraphs unchanged] Customers have access to Dr Foster’s Telstra Health UK’s team of qualified data scientists, clinicians, statisticians, mathematicians, and economists. They supplement in-house analytical teams with Dr Foster’s Telstra Health UK’s expert advice and guidance linking, modelling and visualising data and insight. [2 paragraphs unchanged]

Processing activities

The data requested received under this agreement Agreement are initially disseminated by NHS Digital to Imperial College London Dr Foster Unit (ICL DFU) under a separate agreement Agreement DARS-NIC-12828-M0K2D. ICL DFU pseudonymise the data and then transfer it securely to Dr Foster. Telstra Health UK. Imperial College London Dr Foster Unit (ICL DFU) receives data monthly from NHS Digital under agreement Agreement DARS-NIC-12828-M0K2D. This includes de-identified HES data used for research by ICL DFU which is also processed with further pseudonymisation for secure transfer to Dr Foster. Telstra Health UK. ICL DFU’s additional pseudonymisation of the de-identified HES data removes the HESID [5 words unchanged] replaces it with a new encrypted value that cannot be re-identified by Dr Foster. Telstra Health UK. A unique identifier, known as the FOSID, is added by ICL DFU to each row of data. The FOSID is shared with Dr Foster. Telstra Health UK. The FOSID allows Dr Foster Telstra Health UK to process data without being able to identify patients but at the [42 words unchanged] Number (LOPATID or NHSNO) so the care provider can review patients’ records. Dr Foster Telstra Health UK do not have access to this re-identification service and cannot see any re-identified data. This data all remains with ICL DFU under DARS-NIC-12828-M0K2D. The FOSID allows authorised individuals within Provider Trusts to identify their own patients indicated in Dr Foster’s Telstra Health UK’s healthcare performance tools at an episode level. If the data flowed directly from NHS Digital to Dr Foster Telstra Health UK in pseudonymised form, it would not have these ICL DFU generated FOSIDs, which are ultimately used for authorised NHS customers to re-identify patients in Dr Foster Telstra Health UK tools without the requirement for Dr Foster Telstra Health UK to process identifiable HES. The re-identification service allows ICL DFU to supply NHS Provider Trusts with NHS Number and LOPATID using Dr Foster Telstra Health UK healthcare performance tools without passing these identifiers on to Dr Foster. Telstra Health UK. No patient identifiers will ever be passed to Dr Foster Telstra Health UK or any other organisation except the NHS Provider Trust from where the data originated. ECDS data will be processed in parallel to HES A&E until the ECDS transition process is complete. It will be linked with HES received under this agreement. Initially this linkage will only be possible where the patient attended emergency centres and subsequently was admitted to hospital using the EPIKEY field. Work to facilitate full linkage is ongoing at NHS Digital. Telstra Health UK’s ISO 27001 certified Information Security Management System (ISMS) Dr Foster’s ISO 27001 certified Information Security Management System (ISMS) The processing of the pseudonymised HES data is within the scope of the ISO 27001 certified Information Security Management System (ISMS). Telstra Health UK processes are subject to internal and external audit. All staff receive initial information governance training followed by mandatory monthly modules. The processing of the pseudonymised HES data is within the scope of the ISO 27001 certified Information Security Management System (ISMS). Dr Foster processes are subject to internal and external audit. All staff receive initial information governance training followed by mandatory monthly modules. The pseudonymised data are held securely on Telstra Health UK systems with access permissions only granted as necessary to specific roles. The pseudonymised data are held securely on Dr Foster systems with access permissions only granted as necessary to specific roles. Telstra Health UK tools Dr Foster tools The data are processed through products in the Telstra Health UK toolkit to provide: The data are processed through products in the Dr Foster toolkit to provide: [10 paragraphs unchanged] An extract of processed data is used for conducting bespoke analytical services [36 words unchanged] analyses that are not implemented during routine processing of data for the Dr Foster Telstra Health UK toolkit. [1 paragraph unchanged] The scope of analytics projects is by nature bespoke and customised to [32 words unchanged] additional insight from the data that cannot be gained through use of Dr Foster Telstra Health UK toolkit. Examples of bespoke analytics projects conducted by Dr Foster Telstra Health UK are: • Supporting the NHS Improvement Getting It Right First Time (GIRFT) programme by delivering specialty specific data packs. The data packs developed by Dr Foster, Telstra Health UK, include the derivation of bespoke indicators from HES data to measure the quality and efficiency of care in a particular specialty. [2 paragraphs unchanged] An established team of Analysts conduct all bespoke analytics projects. All analysts [35 words unchanged] with the HES Analysis Guide Guidelines. (Where there is any doubt, the Dr Foster Telstra Health UK Head of Information Governance or SIRO will provide guidance and if required contact NHS Digital.) Outputs are typically provided in data tables to NHS customers. Dr Foster Telstra Health UK may also produce data visualisations (e.g. bar charts, box plots, funnel plots) based on the aggregate-level information from the data tables. [6 paragraphs unchanged] Dr Foster Telstra Health UK users only have access to the data necessary for them to carry [24 words unchanged] and only made available to users subject to approval and risk assessment. [5 paragraphs unchanged] Dr Foster Telstra Health UK conduct research on HES data to provide thought leadership in the field [7 words unchanged] and refine methodologies for evaluating, monitoring, and improving performance within healthcare organisations. Dr Foster Telstra Health UK publish the outputs of research for the benefit of the NHS, health and social care, and the public. Such content may be published directly by Dr Foster Telstra Health UK as articles to journalistic/media entities, or within academic journals. Dr Foster Telstra Health UK may also collaborate with other research groups by providing aggregate analyses to support publications expected to benefit the NHS and health and social care. [3 paragraphs unchanged] Data will only be accessed and processed by substantive employees of Dr Foster. Telstra Health UK. Under this agreement, Telstra Health UK are also permitted to receive the relevant AHAS bridging files released from NHS Digital to Imperial College London under the connected agreement DARS-NIC-12828-M0K2D in order to link HES datasets.

Expected output

[1 paragraph unchanged] • Dr Foster Telstra Health UK online tools and services including the Healthcare Intelligence Portal [25 paragraphs unchanged] Dr Foster Telstra Health UK plan to work with ECDS data immediately so that it can continue to give its customers insight based on emergency care data. Dr Foster Telstra Health UK aims to output services through its tools within the first few months of receiving it. [2 paragraphs unchanged] Examples of previous publications produced by Dr Foster Telstra Health UK include the Hospital Guide that published analysis of the variations in acute [6 words unchanged] healthcare professionals, patients and the public and insight articles published on the Dr Foster Telstra Health UK website. In January 2020, Telstra Health UK (then named Dr Foster Foster) undertook statistical analyses of abdominal aortic aneurisms and trans-catheter aortic valve implementations and found interesting correlations between surgeon annual volume and mortality. Following on from this, the Dr Foster Telstra Health UK team carried out an analysis that examined how the number of annual [16 words unchanged] published at https://drfoster.com/2020/01/30/detailed-analysis-of-knee-replacement-annual-volume-reveals-its-significant-effect-on-readmission-rates/. Other Insights reports and briefings are available at https://drfoster.com/insights/. [1 paragraph unchanged] Dr Foster Telstra Health UK are aware that publications, whether inside or outside the NHS, must adhere [60 words unchanged] as defined in the Terms and Conditions of the Data Sharing Agreement. [1 paragraph unchanged]

Expected measurable benefits

[5 paragraphs unchanged] • Understanding areas of best practice amongst Dr Foster Telstra Health UK customers and facilitate interactions with other customers who are not performing as well to support quality and efficiency improvement. [11 paragraphs unchanged] Benefits are ongoing as the outputs described above are used within NHS Trusts’ internal monthly reporting and quality processes. Dr Foster Telstra Health UK services allow performance of NHS Provider Trusts to be monitored and trended [27 words unchanged] worked with them to understand the causes of worse than expected performance. [1 paragraph unchanged] These benefits are achieved continually and are reliant on a range of factors outside of Dr Foster's Telstra Health UK's control. However, whenever there are areas of concern about performance against key indicators, Dr Foster Telstra Health UK act immediately to alert relevant stakeholders to help in better understanding and addressing them.

Benefits reported

Covid-19 dashboard providing analysis of Trusts’ crude and risk-adjusted mortality rates and in comparison to peers and a national benchmark. (March 2021) Telstra Health UK developed a COVID-19 mortality risk model on the HES (Hospital Episode Statistics) Admitted Patient Care dataset to: 1. Create national benchmarks allowing Trusts to compare their COVID-19 mortality against peers taking into account patient case-mix 2. Provide a COVID-19 mortality relative risk for each Trust to be surfaced in a dashboard 3. Identify the most important factors within the COVID-19 cohort leading to mortality at a Trust and/or site level and comparing these to a national or peer group average “It’s a great tool and gives exactly the kind of external assurance we need, I think the demographic and risk factor analysis is very helpful”. Prof Mark Pietroni MA MBA FFPH FRCP DTM&H, Director for Safety and Medical Director, Deputy Chief Executive, Gloucestershire Hospitals NHS FT Analysis of homeless patient inequalities (February 2021) After consultation with University College London Hospitals, which recently established a multidisciplinary collaboration in response to homelessness, Telstra Health UK set out to produce a suite of analysis using the Hospital Episode Statistics (HES) Admitted Patent Care data to identify and understand comparative characteristics of homeless patients nationally. The analysis sought to identify the shared characteristics of homeless patients, what their needs are, and to highlight some of the differences they have in experiences and outcomes to the rest of the population. The report is freely available on the Telstra Health UK website. Analysis of decline in admissions during first wave of pandemic (October 2020) Dr Foster analysis published in the Daily Telegraph, and then picked up by other media organisations, showed that during the height of the first wave of the COVID-19 pandemic in the UK in April-May 2020, there was a sharp drop in admissions relating to a number of diseases. The reporting informed public awareness and sparked discussion with healthcare professionals, including for example, warnings of longer term impacts and encouragement for people to contact their GP if they need medical treatment. [1 paragraph unchanged] Dr Foster’s Telstra Health UK’s awareness raising publications have provided professionals and the public with insight into [27 words unchanged] the past 10 years by using respiratory and frailty data from HES. [1 paragraph unchanged] Dr Foster’s Telstra Health UK’s frailty analysis has been used by the British Red Cross create a [26 words unchanged] focus help on the most vulnerable people whose needs aren’t being met. [1 paragraph unchanged] Dr Foster Telstra Health UK continues to raise public and professional awareness. Its High Intensity User (HIU) [66 words unchanged] relation to the most common reasons that HIUs are admitted to hospital. Dr Foster Telstra Health UK also measure benefits through customer feedback for their products and services. [19 paragraphs unchanged] Imperial College Healthcare NHS Trust has been a longstanding customer of Dr Foster Telstra Health UK with a dedicated Business Insight Manager based at the trust who has [12 words unchanged] expert resource supports mortality monitoring, market share analysis and efficiency indicator benchmarking. Dr Foster Telstra Health UK data is now integrated into strategic planning and service redesign and has [11 words unchanged] other trusts. As part of North West London’s Shaping a Healthier Future, Dr Foster’s Telstra Health UK’s analytic support has helped the trust in service redesign work, for example in integrating services previously provided by Ealing Hospital. [9 paragraphs unchanged]

Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Datasets: + Emergency Care Data Set (ECDS)

Objective for processing

Data will be processed by Dr Foster under the GDPR lawful basis Legitimate Interest - Article 6(1)(f). Dr Foster has a legitimate interest in being able to provide tools and services that healthcare organisations will find useful and that will benefit the health and social care system. Without processing this data Dr Foster would not be able to deliver these tools and services, to the detriment of health professionals who use the products. Dr Foster's customers can be assured that the tools and services are based on evidence provided by data from a trusted source; there is no viable alternative as relying on public domain data would lead to gaps and not allow the same support for decision making. Using pseudonymised data allows Dr Foster to deliver evidence-based insight and analysis while minimising intrusion into a patient's privacy. If patients are uncomfortable with their data being used for purposes beyond their care then they may manage their patient data choices via the National Data Opt-Out. Aim and purpose of this application: Dr Foster Limited requires the pseudonymised HES datasets (Dr foster) has provided objective insight and analysis since 1999. Dr Foster’s aim is to help healthcare health and social care organisations achieve sustainable improvements in their performance, to gain make better and faster decisions with data and insight and and, ultimately, to inform decision making. benefit patients. This is delivered in three main strands: • Dr Foster tools and services – to provide management information, analysis and clinical benchmarking through online products and services services. • Bespoke analytics – to deliver customised projects to meet individual customer needs needs. • Research for publication – to provide thought leadership in the field [6 words unchanged] aim of improving the planning, delivery and outcome of health and social care care. The data being requested under this agreement flow through are initially sent to Dr Foster via Imperial College London Dr Foster Unit (ICL DFU). DFU) under a separate agreement DARS-NIC-12828-M0K2D. ICL DFU pseudonymise the data further and then securely transfer it to Dr Foster Limited Limited. Dr Foster is a completely different legal entity from ICL DFU, DFU. Dr Foster Limited do not have any control over data held by ICL DFU. Please see 'Processing Activities' for more information on ICL DFU’s pseudonymisation of the data. [1 paragraph unchanged] HES data is sent by NHS Digital to ICL DFU. ICL DFU further pseudonymise the data (described in more detail in the processing section of the agreement) and then transfer it securely to Dr Foster. Dr Foster cannot identify individuals in this data but the additional pseudonymisation process means that authorised Dr Foster NHS customers can take an additional service through ICL DFU to identify patients in Dr Foster tools. Dr Foster cannot identify individual patients in the data and does not have access to the re-identification service. This application is to renew the existing datasets and to add the Emergency Care Data Set (ECDS), so that it can be processed in parallel with the other data received under this agreement. This will allow tools and services that depend on Hospital Episodes Statistics Accident & Emergency (HES A&E) to continue once that is no longer available. It will also allow for related development work to ensure both that the services can continue and that new and more in-depth analysis based on ECDS can be offered. Dr Foster requires the maximum overlap of ECDS with A&E data to provide continuity in its product line with respect to emergency care data. The existing analytical tools provide insight based on the A&E dataset that our current data sharing agreement permits us to hold (back to 2007/08), but any new tools developed to use ECDS data will have a much shorter period of historic data since it is not possible to map A&E data to the new standard. There is potential for duplication of data by processing both HES A&E and ECDS for the period from 2017/18 onwards. However, there will be gaps in the ECDS for this period as Trusts became accustomed to sending the new data. Processing both datasets will allow Dr Foster to account for these gaps and provide its customers with historical emergency care insight and analysis that's based on the most complete data available. Dr Foster has applied for the maximum period of ECDS data available to mitigate this shortfall as much as possible. Data controller Dr Foster Limited is the data controller for data provided under this agreement (DARS-NIC-68697-R6F1T). General Data Protection Regulation legal bases Dr Foster process the data under General Data Protection Regulation (GDPR) articles 6(1)(f) (legitimate interests) and 9(2)(j) (archiving in the public interest). Dr Foster determined the legal bases by undertaking a legitimate interests assessment and a data protection impact assessment. These documents are maintained and updated as necessary by Dr Foster. Dr Foster has a legitimate interest in being able to provide tools and services that healthcare organisations will find useful and that will benefit the health and social care system. Without processing this data, Dr Foster would not be able to deliver these tools and services. Withdrawing these would be to the detriment of health professionals who use them. Dr Foster's customers can be assured that the tools and services are based on evidence provided by data from a trusted source. There is no viable alternative as relying on public domain data would lead to gaps and not allow the same support for decision making. Using pseudonymised data allows Dr Foster to deliver evidence-based insight and analysis while minimising intrusion into a patient's privacy. If patients are uncomfortable with their data being used for purposes beyond their care, then they may manage their patient data choices via the National Data Opt-Out. Dr Foster has a legitimate interest in continuing to offer its customers tools and services that provide insight and analysis into emergency care provision through the processing of the additionally requested ECDS data. Dr Foster also has a legitimate interest in developing new ways to help its customers improve their services and utilise the ECDS to its full potential. The healthcare professionals using Dr Foster's tools and services have an interest in knowing that the insight and analysis of emergency care data can continue and with the improvements offered by ECDS. This will allow a better understanding of capacity and demand and will be used to drive improved patient care, which is in the broader interest of everyone using the health and social care services in England. The processing of this data is also necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) of GDPR. The processing is proportionate to its aims, respects data protection rights and provides suitable and specific measures to protect the rights and interests of individuals. It is necessary for reasons of public interest in the area of public health, in particular to ensure high standards of quality and safety of health care. Although Dr Foster are not a public body, they provide services to help public healthcare organisations to monitor and improve their services. Processing is designed to benefit patients and society as a whole through better healthcare. Imperial College London Dr Foster Unit (ICL DFU) and additional pseudonymisation Imperial College London Dr Foster Unit (ICL DFU) is a separate legal entity to Dr Foster Limited. Dr Foster Limited do not have control over the data processed by ICL DFU. Data requested under this agreement is sent by NHS Digital to ICL DFU. ICL DFU further pseudonymises the data (described in more detail in ‘Processing Activities’) and then transfer it securely to Dr Foster. Dr Foster cannot identify individuals in this data, but the additional pseudonymisation process means that authorised Dr Foster NHS customers can take an additional service through ICL DFU to identify patients in Dr Foster tools. Dr Foster cannot identify individual patients in the data and does not have access to the re-identification service. ICL DFU’s additional pseudonymisation of the de-identified HES data removes the HESID supplied by NHS Digital and replaces it with a new encrypted value that cannot be re-identified by Dr Foster. A unique identifier, known as the FOSID, is added by ICL DFU to each row of data. The FOSID is shared with Dr Foster. The FOSID allows Dr Foster to process data without being able to identify patients but at the same time allowing authorised NHS customers to use it with ICL DFU’s re-identification service. The re-identification service allows authorised users at care providers to further investigate patients under their care. The FOSID is used to extract the local patient identifier or NHS Number (LOPATID or NHSNO) so the care provider can review patients’ records. Dr Foster do not have access to this re-identification service and cannot see any re-identified data. This data all remains with ICL DFU under DARS-NIC-12828-M0K2D. [6 paragraphs unchanged] • Clinician and specialty bench marking benchmarking review Dr Foster online products are used by: Purpose of the request • NHS Provider Trusts– Subscribed authorised users in customer organisations can view data that relate to their organisation at a record level. They cannot access record level HES data relating to other organisations. Dr Foster require the complete pseudonymised HES datasets, Civil Registration mortality data and the Emergency Care Data Set (ECDS) to help healthcare organisations achieve sustainable improvements in their performance, to gain insight and to inform decision making. • Other NHS organisations – Subscribed authorised users in customer organisations can view aggregated analysis which provides valuable insight but prevents any patients from being identified, in accordance with guidance provided by NHS Digital. The required data to meet the purpose are: • Care Quality Commission – CQC can view aggregated analysis. HES Critical Care The Analytics team provides aggregate level and small number suppressed analysis and insight to a number of NHS customers including: HES Admitted Patient Care • NHS Trusts HES Outpatients • Clinical Commissioning Groups HES Accident and Emergency • Commissioning Support Units Civil Registration (Deaths) - Secondary Care Cut • Department of Health HES:Civil Registration (Deaths) bridge • NHS England Emergency Care Data Set (ECDS) • NHS Improvement Dr Foster use the data provided under this agreement to provide a management information function in the form of analysis and clinical benchmarking for healthcare organisations and to increase the power of predictive models for rare diseases, procedures and events. Dr Foster build standard case mix adjustment models for 259 diagnosis groups and 200 procedure groups which include some rarer conditions. Using all the requested datasets means that Dr Foster have the most up to date information and can inform customers of potential issues around quality and in turn they can make better informed decisions for the improvement of healthcare and outcomes for patients. • Care Quality Commission At a high-level Dr Foster analyses break down into the following: • Public Health England • National Institute for Health and Care Excellence Dr Foster plan to also work with: • Non-NHS organisations providing services to benefit the NHS - It is proposed that these will be supplied with aggregate, small-number suppressed analyses. • Non-NHS organisations to benefit public health and social care - It is proposed that these will be supplied with aggregate, small-number suppressed analyses where benefits can be identified for the health and social care system. It is also proposed that algorithms or coefficients that have been derived through research on HES data may be provided directly to a customer for implementation on their own local data. Data provided in all outputs will be at an aggregate level and small number suppression will be implemented in line with HES analysis guidelines. At present no analyses have been provided to non-NHS organisations. Any request for such analysis will be reviewed to determine if it benefits the health and social care system. Dr Foster will inform NHS Digital of analysis it provides to non-NHS organisations and will list this in any renewal or amendment to this agreement. The Analytics team provides bespoke analytics and data science tailored to specific needs to identify clinical variation, efficiency savings, predict patient risk and improve patient outcomes. They are a skilled team of experts in advanced healthcare analytics and data science including predicative analytics, machine learning techniques and advanced statistical methods. The team use this expertise to investigate issues and transform healthcare services. Customers have access to Dr Foster’s team of qualified data scientists, clinicians, statisticians, mathematicians, and economists. They supplement in-house analytical teams with Dr Foster’s expert advice and guidance linking, modelling and visualising data and insight. Dr Foster’s aim is to help improve health and social care decision making and planning and, ultimately, to benefit patients. Dr Foster use the data provided under this agreement to provide a management information function in the form of analysis and clinical benchmarking for healthcare organisations and to increase the power of predictive models for rare diseases, procedures and events. Dr Foster build standard casemix adjustment models for 259 diagnosis groups and 200 procedure groups which include some rarer conditions. Using all pseudonymised HES datasets means that Dr Foster have the most up to date information and can inform customers of potential issues around quality and in turn they can make better informed decisions for the improvement of healthcare and outcomes for patients. At a high level Dr Foster analyses break down into the following: [18 paragraphs unchanged] NHS subscribers to the tools have access to analysis of HES data so that they can: The data allow Dr Foster to provide a wide array of relevant indicators to give end users as complete a picture of hospital performance as possible to allow health and social care organisations to effectively: • Track and trend performance, identify areas for efficiency savings and understand and influence demand and patient flow throughout the health and care system. • Investigate risk-adjusted quality, patient safety and clinical outcomes data including mortality, benchmark against other healthcare organisations and identify areas for improvement. Dr Foster has provided objective insight and analysis since 1999. Dr Foster requires all HES datasets in pseudonymised form to provide a wide array of relevant indicators to give end users as complete a picture of hospital performance as possible to allow health and social care organisations to effectively: [3 paragraphs unchanged] A data period of 15 years of historical data is essential to enable Dr Foster to: Civil Registration (Deaths) - Secondary Care Cut specific purposes • Obtain longitudinal data on prior admissions for patients. Risk modelling will also require access to variables on prior admissions including previously recorded co-morbidities. • Create, update and maintain statistical risk models to enable the regular production of risk adjusted measures of mortality, quality and efficiency (including Hospital Standardised Mortality Ratio (HSMR) and CUSUM alerts as used by NHS organisations and regulators). HSMR is the ratio of observed deaths that occurred following admission in a provider to a modelled expectation of deaths (multiplied by 100) on the basis of the average England death rates for 56 specific clinical groups given a selected set of patient characteristics for those treated there. CUSUM is short for ‘cumulative sum’. The charts show the cumulative sum of the differences between expected outcomes and actual outcomes over a series of patients. The total difference is recalculated for each new patient and plotted on a chart cumulatively (i.e. where one patient’s difference ends the next one starts). They are used to detect small sustained increases in risk relating to quality outcomes, such as mortality, long length of stay and readmissions and usually for a single provider and diagnosis/procedure group. When a number of patients have a negative outcome one after the other, the CUSUM could hit a threshold, triggering an alert. This could indicate that the situation is out of control for that particular strata. In simplistic terms for the example of mortality, every time a patient dies the graph goes up, every time a patient survives it goes down. The amount that it goes up or down depends on the risk, so if a low risk patient dies it will go up more than if a high risk patient dies. The CUSUM technique is associated with false positive and false negative states. A false positive is when the CUSUM gives an alarm when in actual fact performance is at an acceptable level and the rate of the poor outcomes has not changed. It is necessary for reasons of public interest in the area of public health, in particular to ensure high standards of quality and safety of health care. Although Dr Foster are not a public body they provide services to help public healthcare organisations monitor and improve their services. Processing is designed to benefit patients and society as a whole through better healthcare. Dr Foster require the complete pseudonymised HES datasets including Civil registration mortality data to help healthcare organisations achieve sustainable improvements in their performance, to gain insight and to inform decision making. [1 paragraph unchanged] These data are extremely critical because mortality information may be a surrogate metric for success of medical care. Therefore Therefore, this dataset will enable identification of factors that drive successful treatment of a patient. patients. Cause and date of death may also be used to identify trends [5 words unchanged] particular groups of patients. Historical death data are necessary for identifying trends. The capability to link the already held HES datasets with mortality data [13 words unchanged] condition and at the same stage can have very different outcomes. In addition addition, it would be used to: [13 paragraphs unchanged] a) as stated above, Dr Foster will not re-identify; in addition, given the volumes of data, identification will serves no purpose to Dr Foster anyway Foster. [4 paragraphs unchanged] d) those Trusts already have a means of re-identifying those patients: the re-identification service provided by the Dr Foster Unit at Imperial College London Emergency Care Data Set (ECDS) specific purposes Dr Foster are amending their application to request Emergency Care Data Set (ECDS), in parallel to HES A&E, until the ECDS transition process is complete, so that it can: • continue to deliver products and services that provide insight into and analysis of emergency care provision; • develop enhancements to its services that utilise the greater detail provided by ECDS, • transition its products from A&E data to reduce any interruption for NHS healthcare professionals that rely on these tools and services; • quality assure its processing of ECDS. Historical ECDS data is necessary for more useful trend analysis, research, and quality assurance. The additional fields within ECDS will help Dr Foster to: • improve understanding of the complexity of attending patients and the causes of rising demand; • capture diagnostic data for richer information on the diagnosis with which patients are presenting to emergency departments; • enhance the understanding of the value of emergency departments; • enhance understanding of need, activity and outcomes; • better understand patient pathways such as type 5 emergency admissions (same day emergency care), which are currently not coded within HES. Mental health fields within ECDS will be used by Dr Foster: • To help better understand the cohort of patients seen in the Emergency Department with mental health conditions who are both formally and informally detained under the Mental Health Act. • To help emergency care departments understand how the above patients use their services and what affect this may have on departments. Ethnicity fields within ECDS will be processed to • build risk models which take into account patient ethnicity • better understand the patient demographic for population health projects Number of years requested A data period of 15 years of historical data is essential to enable Dr Foster to: • Obtain longitudinal data on prior admissions for patients. Risk modelling will also require access to variables on prior admissions including previously recorded co-morbidities. • Create, update and maintain statistical risk models to enable the regular production of risk adjusted measures of mortality, quality and efficiency (including Hospital Standardised Mortality Ratio (HSMR) and the cumulative sum (CUSUM) alerts as used by NHS organisations and regulators). HSMR is the ratio of observed deaths that occurred following admission in a provider to a modelled expectation of deaths (multiplied by 100) on the basis of the average England death rates for 56 specific clinical groups given a selected set of patient characteristics for those treated there. The charts show the cumulative sum of the differences between expected outcomes and actual outcomes over a series of patients. The total difference is recalculated for each new patient and plotted on a chart cumulatively (i.e. where one patient’s difference ends the next one starts). They are used to detect small sustained increases in risk relating to quality outcomes, such as mortality, long length of stay and readmissions and usually for a single provider and diagnosis/procedure group. When a number of patients have a negative outcome one after the other, the CUSUM could hit a threshold, triggering an alert. This could indicate that the situation is out of control for that particular strata. In simplistic terms for the example of mortality, every time a patient dies the graph goes up, every time a patient survives it goes down. The amount that it goes up or down depends on the risk, so if a low risk patient dies it will go up more than if a high-risk patient dies. The CUSUM technique is associated with false positive and false negative states. A false positive is when the CUSUM gives an alarm when in fact performance is at an acceptable level and the rate of the poor outcomes has not changed. Users of Dr Foster products and services NHS subscribers to Dr Foster tools have access to analysis of the data so that they can: • Track and trend performance, identify areas for efficiency savings and understand and influence demand and patient flow throughout the health and care system. • Investigate risk-adjusted quality, patient safety and clinical outcomes data including mortality, benchmark against other healthcare organisations and identify areas for improvement. Dr Foster online products are used by: • NHS Provider Trusts– Subscribed authorised users in customer organisations can view data that relate to their organisation at a record level. They cannot access record level HES data relating to other organisations. • Other NHS organisations – Subscribed authorised users in customer organisations can view aggregated analysis which provides valuable insight but prevents any patients from being identified, in accordance with guidance provided by NHS Digital. • Care Quality Commission – CQC can view aggregated analysis. The Analytics team provides aggregate level and small number suppressed analysis and insight to a number of NHS customers including: • NHS Trusts • Clinical Commissioning Groups • Commissioning Support Units • Department of Health • NHS England • NHS Improvement • Care Quality Commission • Public Health England • National Institute for Health and Care Excellence Dr Foster also work with: • Non-NHS organisations providing services to benefit the NHS – these are only supplied with aggregate, small-number suppressed analyses. • Non-NHS organisations to benefit public health and social care - these are only supplied with aggregate, small-number suppressed analyses where benefits can be identified for the health and social care system. It is also proposed that algorithms or coefficients that have been derived through research on HES data may be provided directly to a customer for implementation on their own local data. Data provided in all outputs will be at an aggregate level and small number suppression will be implemented in line with HES analysis guidelines. Any request for such analysis is reviewed to determine if it benefits the health and social care system. Dr Foster will inform NHS Digital of analysis it provides to non-NHS organisations and will list this in any renewal or amendment to this. Dr Foster provided analysis on COVID-19 to the British Red Cross in May 2020. This was frailty analysis by Lower Super Output Area (LSOA) which included the following: • Proportion of frail patients with mobility problems • Proportion of frail patients with mobility problems and a fracture. These were percentages only and included no small numbers. Customers have access to Dr Foster’s team of qualified data scientists, clinicians, statisticians, mathematicians, and economists. They supplement in-house analytical teams with Dr Foster’s expert advice and guidance linking, modelling and visualising data and insight. The Analytics team provides bespoke analytics and data science tailored to specific needs to identify clinical variation, efficiency savings, predict patient risk and improve patient outcomes. They are a skilled team of experts in advanced healthcare analytics and data science including predicative analytics, machine learning techniques and advanced statistical methods. The team use this expertise to investigate issues and transform healthcare services.

Processing activities

The data requested under this agreement are initially sent disseminated by NHS Digital to Imperial College London Dr Foster Unit (ICL DFU) under a separate agreement NIC-12828. DARS-NIC-12828-M0K2D. ICL DFU pseudonymise the data and then transfer it securely to Dr Foster. Imperial College London Dr Foster Unit (ICL DFU) receives data monthly from NHS Digital under agreement NIC-12828. This includes de-identified HES data used for research by ICL DFU which is also processed with further pseudonymisation for secure transfer to Dr Foster. The HES data will be linked to the civil registration data before being passed onto Dr Foster. ICL DFU’s additional pseudonymisation of the de-identified HES data removes the HESID supplied by NHS Digital and replaces it with a new encrypted value that cannot be re-identified by Dr Foster. A unique identifier, known as the FOSID, is added by ICL DFU to each row of data. Imperial College London Dr Foster Unit (ICL DFU) receives data monthly from NHS Digital under agreement DARS-NIC-12828-M0K2D. This includes de-identified HES data used for research by ICL DFU which is also processed with further pseudonymisation for secure transfer to Dr Foster. ICL DFU’s additional pseudonymisation of the de-identified HES data removes the HESID supplied by NHS Digital and replaces it with a new encrypted value that cannot be re-identified by Dr Foster. A unique identifier, known as the FOSID, is added by ICL DFU to each row of data. The FOSID is shared with Dr Foster. The FOSID allows Dr Foster to process data without being able to identify patients while but at the same time allowing authorised NHS customers to use it with ICL DFU’s re-identification service. [11 words unchanged] investigate patients under their care. The FOSID is used to extract the NHSNO local patient identifier or LOPATID NHS Number (LOPATID or NHSNO) so the care provider can review patients’ records. Dr Foster do not have access to this re-identification service and cannot see any re-identified data this data. This data all remains with ICL DFU under NIC12828. DARS-NIC-12828-M0K2D. The FOSID allows authorised individuals within Provider Trusts to identify their own [13 words unchanged] the data flowed directly from NHS Digital to Dr Foster in pseudonymised form form, it would not have these ICL DFU generated FOSIDs, which are ultimately [19 words unchanged] process identifiable HES. The re-identification service allows ICL DFU to supply NHS provider trusts Provider Trusts with NHS Number and LOPATID using Dr Foster healthcare performance tools without [12 words unchanged] be passed to Dr Foster or any other organisation except the NHS provider trust Provider Trust from where the data originated. ECDS data will be processed in parallel to HES A&E until the ECDS transition process is complete. It will be linked with HES received under this agreement. Initially this linkage will only be possible where the patient attended emergency centres and subsequently was admitted to hospital using the EPIKEY field. Work to facilitate full linkage is ongoing at NHS Digital. Dr Foster’s ISO 27001 certified Information Security Management System (ISMS) [1 paragraph unchanged] The pseudonymised HES data are held securely on Dr Foster systems with access permissions only granted as necessary to specific roles. Descriptions of processing through Dr Foster tools, analytics and research services are provided below. Dr Foster tools Tools The data are processed through products in the Dr Foster toolkit to provide: HES is processed through products in the Dr Foster toolkit to provide: [12 paragraphs unchanged] The scope of analytics projects are is by their nature bespoke and customised to local needs, however in all cases, the [38 words unchanged] Foster toolkit. Examples of bespoke analytics projects conducted by Dr Foster are: [4 paragraphs unchanged] Getting It Right First Time (GIRFT) “Getting It Right First Time (GIRFT) is a national programme designed to improve medical care within the NHS by reducing unwarranted variations. By tackling variations in the way services are delivered across the NHS, and by sharing best practice between trusts, GIRFT identifies changes that will help improve care and patient outcomes, as well as delivering efficiencies such as the reduction of unnecessary procedures and cost savings.” https://gettingitrightfirsttime.co.uk GIRFT is overseen by NHS Improvement, which is now cooperating with NHS England as a joint enterprise, with the two organisations being referred to as ‘NHS England and Improvement’. To make sure that they comply with data protection obligations NHSI and NHSE have entered into a Joint Controller and Information Sharing Framework Agreement, details of which can be found at https://www.england.nhs.uk/nhse-nhsi-privacy-notice/joint/joint-controller-agreement/. As a result of this NHS Improvement will be working more closely with NHS England and it is their intention that the outputs of data analysis completed using data provided under this agreement will also be shared with NHS England to facilitate service improvement work with Trusts. • All output of bespoke analysis is suppressed as per NHS Digital disclosure rules other than work undertaken for the NHS England/Improvement GIRFT programme, where the Data Controller is required to provide unsuppressed (low count) data in these outputs to enable national clinical leads, who are NHS employees, to explore and understand low volume activity in their conversations with providers as part of the picture of the service that is being considered. These outputs are produced by the Data Controller and shared securely with the GIRFT programme. All users working on the GIRFT program (and any organisation receiving a report as outlined below), where unsuppressed small numbers data may be visible, are informed of the terms of use which state that they must not seek to re-identify any individual from that data. Data with small numbers included will only be shared within the programme where it is deemed absolutely necessary, and only after a local risk assessment has taken place and where sufficient controls are in place to manage any risks. Such considerations include that the geography of the data makes any risk of re-identification remote, limited patient demographics are included, data is presented across a whole quarter/year or where any risk of re-identification is not possible without unreasonable effort. The test that will be applied by GIRFT is that 'the requirements for the need to share the unsuppressed data outweigh any risks posed and that all mitigated actions would be taken'. Dr Foster users only have access to the data necessary for them to carry out their tasks, are reminded of their responsibilities for confidentiality and data protection, and receive regular training. Within the GIRFT programme access is managed and only made available to users subject to approval and risk assessment. Reports containing unsuppressed data may only be shared by NHSE/I with : a. individual organisations to whom the data relates, and/or b. with other network members (with the agreement of the individual organisation to whom the data relates), and/or c. within NHSE/I in order to achieve the benefits outlined within the GIRFT programme (whilst NHSE and NHSI have an active data sharing agreement with NHS Digital covering the source data). [1 paragraph unchanged] Dr Foster conduct research on HES data to provide thought leadership in the field of healthcare data analytics and to develop and refine methodologies for evaluating, monitoring monitoring, and improving performance within healthcare organisations. Dr Foster publish the outputs of [46 words unchanged] support publications expected to benefit the NHS and health and social care. [4 paragraphs unchanged]

Expected output

[15 paragraphs unchanged] The above outputs depend on processing of HES and Civil Registration all the requested data. Civil Registration mortality data specific outputs [8 paragraphs unchanged] Timeframe for outputs [1 paragraph unchanged] Outputs of bespoke analytics projects are dependent on the nature of the project and can include Tabulations, Dashboards, Reports, Spreadsheets, Presentations or Articles. Outputs may be surfaced through a number of tools including Microsoft Office suite (Excel, Word and PowerPoint etc) or other tools (Tableau, Qlickview) depending on the requirements of the customer. In some instances, algorithms or coefficients that have been derived through research on HES data may be provided directly to a customer for implementation on their own local data. Data provided in all outputs are at an aggregate level and small number suppression is implemented in line with HES analysis guidelines. Bespoke analytics projects are conducted on an ad hoc basis and target dates for delivery of outputs are thus defined upon commencement of each project. Dr Foster plan to work with ECDS data immediately so that it can continue to give its customers insight based on emergency care data. Dr Foster aims to output services through its tools within the first few months of receiving it. Examples of previous publications produced by Dr Foster include the Hospital Guide that published analysis of the variations in acute hospital care for the benefit of healthcare professionals, patients and the public. Outputs of bespoke analytics projects are dependent on the nature of the project and can include tabulations, dashboards, reports, spreadsheets, presentations or articles. Outputs may be surfaced through tools including Microsoft Office suite (Excel, Word and PowerPoint etc) or other tools (Tableau, QlikView) depending on the requirements of the customer. In some instances, algorithms or coefficients that have been derived through research on the data may be provided directly to a customer for implementation on their own local data. Data provided in all outputs are at an aggregate level and small number suppression is implemented in line with HES analysis guidelines. Bespoke analytics projects are conducted on an ad hoc basis and target dates for delivery of outputs are thus defined upon commencement of each project. Publications Examples of previous publications produced by Dr Foster include the Hospital Guide that published analysis of the variations in acute hospital care for the benefit of healthcare professionals, patients and the public and insight articles published on the Dr Foster website. In January 2020, Dr Foster undertook statistical analyses of abdominal aortic aneurisms and trans-catheter aortic valve implementations and found interesting correlations between surgeon annual volume and mortality. Following on from this, the Dr Foster team carried out an analysis that examined how the number of annual knee replacement procedures performed within a trust influences the rate of readmission. Insights from this are published at https://drfoster.com/2020/01/30/detailed-analysis-of-knee-replacement-annual-volume-reveals-its-significant-effect-on-readmission-rates/. Other Insights reports and briefings are available at https://drfoster.com/insights/. Dr Foster provide an interactive dashboard on its website to provide information to help manage and predict the risk of COVID-19 for England. The respiratory and frailty data are from HES. The dashboard was initially published in April 2020 and is updated regularly at https://drfoster.com/2020/04/06/uk-covid-19-progression-dashboard. [2 paragraphs unchanged]

Expected measurable benefits

[14 paragraphs unchanged] • Helping providers address pressures on the emergency care services by identifying opportunities to relieve these pressures • Helping providers improve patient outcomes and experiences [3 paragraphs unchanged] As a majority of These benefits are achieved on an ongoing basis, it is not possible to outline a specific target date for achievement of the benefits outlined as they continually and are reliant on a range of factors outside of Dr Foster's control. However, whenever there are areas of particular concern about performance against key indicators, Dr Foster act immediately to alert relevant stakeholders and offer assistance to help in better understanding and addressing them.

Benefits reported

Dr Foster measure benefits through customer feedback for their products and services: COVID-19 heatmaps (April 2020) “Clinicians and analysts use Healthcare Intelligence Portal (HIP) on a daily basis to analyse new patient safety alerts, high standardised mortality ratios and individual cases. Dr Foster investigate areas of concern in clinical coding and data analysis and look to improve future patient care through retrospective review and analysis.” Northampton General Hospital NHS Trust (February 2015) Dr Foster’s awareness raising publications have provided professionals and the public with insight into the progression of COVID-19. Their interactive dashboard, first released in April 2020, uses heatmaps to show the spread of the disease. It also shows historical perspectives within the past 10 years by using respiratory and frailty data from HES. “Our data quality team use HIP to identify patients with missing or duplicate information and whether the problem is ongoing and needs a change in process to rectify it or whether it’s due to individual oversight.” Northern Devon Healthcare NHS Trust (February 2015) Frailty analysis for British Red Cross (May 2020) “We carried out a review of dermatological deaths and the data in HIP identified that the deaths were due to cellulitis. We reviewed treatment options based on this and identified where improvements could be made.” Wrightington, Wigan and Leigh NHS Foundation Trust (February 2015) Dr Foster’s frailty analysis has been used by the British Red Cross create a COVID-19 vulnerability index for the UK, mapping clinical vulnerability, economic vulnerability, social vulnerability and other health and wellbeing needs. This is helping the British Red Cross focus help on the most vulnerable people whose needs aren’t being met. “We use HIP to undertake many audits and reviews at any one time. For example, ten sets of case notes are reviewed each month by an emergency department consultant as part of our programme to improve performance on sepsis.” High Intensity User (HIU) report (January 2019) The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust (February 2015) Dr Foster continues to raise public and professional awareness. Its High Intensity User (HIU) report of January 2019 uncovered important characteristics of HIU patients and patterns in their attendances of A&E. It showed that the vast majority of HIUs are living in the most deprived areas of England, suggesting that the most vulnerable members of society may be more prone to high intensity use. Smoking, drugs and alcohol all appear to play an important role in frequent A&E use, in relation to the most common reasons that HIUs are admitted to hospital. Dr Foster also measure benefits through customer feedback for their products and services. Case study - North Cumbria University Hospitals NHS Trust (2016) [1 paragraph unchanged] Dr Jeremy Rushmer, Medical Director, North Cumbria University Hospitals NHS Trust (2016) [1 paragraph unchanged] Dr Foster’s HIP is used on at least a weekly basis by the corporate and business intelligence teams and clinical staff to: [14 paragraphs unchanged] Case study - Imperial College Healthcare NHS Trust (October 2018) Imperial College Healthcare NHS Trust has been a longstanding customer of Dr Foster with a dedicated Business Insight Manager based at the trust who has been delivering bespoke analytic support and expertise in clinical benchmarking. This dedicated, expert resource supports mortality monitoring, market share analysis and efficiency indicator benchmarking. Dr Foster data is now integrated into strategic planning and service redesign and has been used to explore growth opportunities for services previously provided by other trusts. As part of North West London’s Shaping a Healthier Future, Dr Foster’s analytic support has helped the trust in service redesign work, for example in integrating services previously provided by Ealing Hospital. The Deputy Chief Information Officer, Imperial College Healthcare NHS Trust stated that, “National benchmarking is possible, but you have to do a lot of work with the data yourselves. With Dr Foster tools the data is easy to access and we can make sure we are keeping pace with other high-performing organisations. Having a Dr Foster analyst on site has been very successful. […] Dr Foster understands what our objectives are and is able to carry out complex analysis on our behalf. It is a fast track way of getting good benchmarking. For example, our performance framework has over 100 different metrics. The Dr Foster tools are useful looking across the Sustainability and Transformation Plan (STP) area to understand what is happening with indicators such as length of stay.” Northampton General Hospital NHS Trust (February 2015) “Clinicians and analysts use Healthcare Intelligence Portal (HIP) on a daily basis to analyse new patient safety alerts, high standardised mortality ratios and individual cases. Dr Foster investigate areas of concern in clinical coding and data analysis and look to improve future patient care through retrospective review and analysis.” Northern Devon Healthcare NHS Trust (February 2015) “Our data quality team use HIP to identify patients with missing or duplicate information and whether the problem is ongoing and needs a change in process to rectify it or whether it’s due to individual oversight.” Wrightington, Wigan and Leigh NHS Foundation Trust (February 2015) “We carried out a review of dermatological deaths and the data in HIP identified that the deaths were due to cellulitis. We reviewed treatment options based on this and identified where improvements could be made.” The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust (February 2015) “We use HIP to undertake many audits and reviews at any one time. For example, ten sets of case notes are reviewed each month by an emergency department consultant as part of our programme to improve performance on sepsis.”